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State of MaineBARBERING & COSMETOLOGYLICENSING PROGRAMThe information in this application packet is to assist you in completing yourapplication. It is recommended that you review applicable laws and rulesfor further guidance.LICENSE BY EXAMINATIONAESTHETICIAN, BARBER, LIMITED BARBER,COSMETOLOGIST, OR NAIL TECHNICIANDo not return the following 3 informational pages with yourapplication; they are for your information onlyDepartment of Professional and Financial RegulationOffice of Professional and Occupational Regulation(Mailing address) 35 State House Station, Augusta, ME 04333(Office location) Gardiner Annex, 76 Northern Avenue, Gardiner, Maine 04345Office Direct Line (207) 624-8579TTY users call Maine relay 711FAX (207) 624-8637Web address: www.m aine.gov/professionallicensingEmail: barbercosm .lic@m aine.govPublished under appropriation 01402A4702012Revised 03/201735 State House Station, Augusta ME 04333Website: www.maine.gov/professionallicensing

APPLICATION INSTRUCTIONSFOR LICENSURE BY EXAMINATIONComplete and submit this application and supporting documents to the Maine Barbering and CosmetologyLicensing Program. The following must be submitted w ith the application:1. Fee;2. Proof that you are at least 17 years of age (a copy of birth certificate or driver’s licenseis acceptable);3. Proof that you have completed at least the 10th grade in a secondary school of learningor its equivalent;4. Transcript or affidavit demonstrating that you have satisfactorily completed yourcourse of study; and5. Written and Practical passing examination scores.NOTE:The Barbering & Cosmetology Licensing Program requires that all supporting documents and fees be submittedwith the filing of your application. All fees are non refundable. Your application will be considered incompleteif your supporting documents and/or fees are omitted. An application that remains incomplete for morethan sixty (60) days will become null and void regardless that you hold a temporary license, ifapplicable. Documents that have been modified or altered (including the use of any white out substance) in anyway will not be accepted.PROCESSING TIME: Your application has a greater chance of being processed expeditiously if it is complete and all supportingdocuments are attached. Please visit our website at www.maine.gov/professionallicensing to monitor yourapplication’s progress in real time. If the status appears as “PENDING”, this means that your application wasreceived by this office, and is pending or under review. Once reviewed, and if everything about yourapplication is complete and complies with requirements, the license will be issued. The status online will showas “ACTIVE”. If your application is incomplete, a letter will be mailed to you. Please refrain from calling our office to “check” on your application as these calls only serve to slowour ability to review and process applications.IMPORTANT INFORMATION REGARDING YOUR LICENSE:The Office no longer prints licenses. You will be notified by email from noreply@maine.gov using the emailaddress you provide on this application. A copy of your license will be attached to that email. (a paper licensewill not be sent by regular mail). The email with your license will contain the access code that is requiredto renew your license online when the time comes. You may also update your contact information and emailaddress on our website www.maine.gov/professionallicensing using your access code.Approximately sixty (60) days prior to the expiration of your license a courtesy renewal reminder will be sent toyou by email. It is important that you maintain a current email on file, or you risk not being able to receive therenewal reminder. You do not need to wait for a renewal reminder to renew your license. The online renewalopens sixty (60) days prior to the license expiring and you may renew online anytime. Failure to receive acourtesy renewal reminder notice does not waive your responsibility to renew your license in a timelymanner.Published under appropriation 01402A4702012Revised 03/201735 State House Station, Augusta ME 04333Website: www.maine.gov/professionallicensing

NOTICES:10 Day Notification RequirementPursuant to 10 MRS §8003-G, any change in name, address, email address, criminal convictions, disciplinary actions, or any material change set forth in your original application for licensure must be reported to the Office within 10 days.You can access this Law for your review at:http://www.m sec0.htm lLAWS AND RULES:Disclosure: Effective July 1, 2012, the Barbering and Cosmetology Licensing Program hasdiscontinued the Maine Laws and Rules portion of the examination and in its place requires theapplicant to attest that s/he will obtain, read and abide by all Maine laws and rules related to thepractice of Barbering and Cosmetology as a part of the application process. Applicants for an initialpractice license are required to take and pass the applicable written and practical examinations inorder to qualify for licensure. The holder of an active license has an obligation and responsibility tokeep abreast of laws and rules and maintaining current and up to date practice standards.Maine Barbering and Cosmetology Laws and Ruleshttp://www.m bers/laws.htm lAll relevant laws and rules are accessible from this web page.Title 5 Administrative Procedures and Services Chapter 5/title5ch341sec0.htmlTitle 10 Department of Business Regulation Law §§8001-8011http://legislature.m aine.gov/statutes/10/title10ch901sec 0.htm lOffice of Professional and Occupational Regulation Rules 02 041http://www.m aine.gov/sos/cec/rules/02/chaps02.htm #041Chapter 10, Establishment of License FeesChapter 11, Late RenewalsThis office cannot provide you with a hardcopy of laws and rules. However, all of these documentsare available online at www.m aine.gov/professionallicensing. Please visit the websites listed above toaccess these documents electronically. These documents may be subject to change without noticeand it is strongly advised that you periodically revisit these sites for any updates.Published under appropriation 01402A4702012Revised 03/201735 State House Station, Augusta ME 04333Website: www.maine.gov/professionallicensing

STATE OF MAINE DEPARTMENT OF PROFESSIONAL & FINANCIAL REGULATIONOFFICE OF PROFESSIONAL AND OCCUPATIONAL REGULATIONMailing Address: 35 State House Station, Augusta, Maine 04333 Courier/Delivery address: 76 Northern Avenue, Gardiner, Maine 04345Phone: (207) 624-8579 Fax: (207) 624-8637 TTY users call Maine relay 711 web: www.maine.gov/professionallicensingFrequently Asked Questions: Where do I send my application? Our mailing address is 35 State House Station, Augusta, Maine04333 -0035 Where are you located? Gardiner Annex Building, 76 Northern Avenue, Gardiner, Maine. What hours are you open? 8:00 AM to 5:00 PM weekdays Can I come to Gardiner to drop off my application? Yes, but you will not leave with a license. Can I come to Gardiner to pick up my license? No. Your license will be e-mailed to you. How long does it take to process an application? You can check your status on our website atwww.maine.gov/professionallicensing. Your license will show up as “PENDING” at first; as soon asyour status is “ACTIVE” you are authorized to practice. How far back do I go answering the criminal question? Any conviction, ever.NOTICES:BACKGROUND CHECK: Pursuant to 5 MRS §5301 - 5303, the State of Maine is granted the authority to take into consideration anapplicant’s criminal history record. The Office of Professional and Occupational Regulation requires a criminal history records check as partof the application process for all applicants.PUBLIC RECORD: This application is a public record for purposes of the Maine Freedom of Access Law (1 MRS §401 et seq). Publicrecords must be made available to any person upon request. This application for licensure is a public record and information supplied aspart of the application (other than social security number and credit card information) is public information. Other licensing records to whichthis information may later be transferred will also be considered public records. Names, license numbers and mailing addresses listed on orsubmitted as part of this application will be available to the public and may be posted on our website.SOCIAL SECURITY NUMBER: The following statement is made pursuant to the Privacy Act of 1974. Disclosure of your Social SecurityNumber Is mandatory. Solicitation of your Social Security Number is solely for tax administration purposes, pursuant to 36 MRS §175as authorized by the Tax Reform Act of 1975 (42 USC §405(C)(2)(C)(i)). Your Social Security Number will be disclosed to the State TaxAssessor or an authorized agent for use in determining filing obligations and tax liability pursuant to Title 36 of the Maine Revised Statutes.No further use will be made of your Social Security Number and it shall be treated as confidential tax information pursuant to 36 MRS §191.Before you seal the envelope, did you: Complete every item on the application (or your application will be canceled as incomplete)Answer the criminal background disclosure questionsSign and date your applicationInclude correct amount (payable to Maine State Treasurer) or credit card information (plus signature)Include any required transcripts or exam resultsMake a copy of your application to keep for your recordsDO NOT SEND CASH.

STATE OF MAINEDEPARTMENT OF PROFESSIONALAND FINANCIAL REGULATIONOFFICE OF PROFESSIONAL AND OCCUPATIONAL REGULATIONINDIVIDUAL LICENSE APPLICATIONAPPLICANT INFORMATION (please print)FIRSTFULL LEGAL NAMEMIDDLE INITIALLASTANY OTHER NAMES EVER USEDDATE OF BIRTHmm / dd / yyyySOCIAL SECURITY NUMBER--MAILING ADDRESSCITYSTATEPHONE # ()FAX # (ZIPCOUNTY)E-MAIL (Your license will be emailed)CRIMINAL BACKGROUND DISCLOSURENOTE: Failure to disclose criminal convictions may result in denial, fines, suspension and/or revocation of a license.1. Have you ever been convicted by any court of any crime? (circle one)NOYESIf yes, enclose a detailed signed description of what happened (including dates) and a copy of the court judgment.2. Has any jurisdiction taken disciplinary action against any professional license you hold or have held,or denied your application for licensure? (circle one)NOYESIf yes, enclose a detailed signed explanation an d copies of all documents.By my signature, I hereby certify that the information provided on this application is true and accurate to the best of my knowledge andbelief. By submitting this application, I affirm that the Office of Professional and Occupational Regulation will rely upon this informationfor issuance of my license and that this information is truthful and factual. I also understand that sanctions may be imposed includingdenial, fines, suspension or revocation of my license if this information is found to be false.SIGNATUREDATEBarbering and Cosmetology Licensing ProgramLicensure by ExaminationAesthetician, Barber, Limited Barber, Cosmetologist or Nail TechnicianRequired Fees: 41.00(Non-Refundable)LICENSE TYPE: YOU MUST CHECK ONE FROMBELOW Aesthetician (AE1421) Barber (BA1421) Nail Technician (MA1421) Limited Barber (LBA1421) Cosmetologist (CO1421)Office Use Only:Check#Amount:Cash#Lic. #1421— 20.002619— 21.00PAYMENT OPTIONS:Make checks payable to “Maine State Treasurer” - If you wish to pay by credit or debit card, please fill out the following:NAME OF CARDHOLDER (please print)FIRSTMIDDLE INITIALLASTI authorize the Department of Professional and Financial Regulation, Office of Professional and Occupational Regulation tocharge myAMERICAN EXPRESSVISAMASTERCARDDISCOVER the following amount: I understand that fees are non-refundableCard number:SIGNATURE XXXX-XXXX-XXXX-XXXXExpiration DateDATEmm / yyyy